Çok yaşlı hastalarda endoskopik retrograd kolanjiyopankreatografi güvenli mi?

Yıl 2019, Cilt: 27 Sayı: 2, 56 - 61, 18.09.2019

Resul Kahraman , Ebru Tarıkçı Kılıç

https://doi.org/10.17940/endoskopi.631867

Öz

Giriş ve
Amaç: Çok yaşlı hastalarda, endoskopik retrograd kolanjiopankreatografinin
güvenilirliği konusunda yeterli bilgi yoktur. Endoskopik retrograd
kolanjiopankreatografi talebinde yaşam beklentisindeki artış ile birlikte bir
artış vardır. Dolayısıyla bu çalışmanın amacı, çok yaşlı hastalardaki endoskopik
retrograd kolanjiopankreatografinin sonuçlarını ve güvenilirliğini
değerlendirmektir. Gereç ve Yöntem: Çalışmaya
Ocak 2014 ile Aralık 2018 arasında endoskopik retrograd kolanjiopankreatografi uygulanan
90 yaş üstü 51 hasta dahil edildi. Demografik özellikler, endikasyonlar, işlem
ve anestezi ile ilişkili yan etkiler, Amerikan Anesteziyologlar Derneği
sınıflaması, eşlik eden komorbid hastalıklar ve sonuçları analiz edildi.
Komorbiditeyi analiz etmek için Charlson Komorbidite İndeksi kullanıldı.
Komorbidite ayrımı için Charlson Komorbidite İndeksi ≥ 2 sayısal tanımı
kullanıldı. Bulgular: Dahil edilen
51 hastanın yaş ortalaması 91.86 (standart sapma = 2.42) yıl olup, 16’sı
erkekti.  En sık endikasyonu safra kanalı
taşları oluşturuyordu (66.7%). Hastaların 42’sine sfinkteretomi yapıldı
(82.4%). Stent ise hastaların 17’sine takıldı (33.3%). Zor kanülasyon oranı
23.5%’di. İşlem ile ilişkili 9 hastada (17.6%), anestezi ile ilgili 12 hastada
(24%) minor yan etkiler görüldü. Ortalama işlem süresi 35.16 dakika (standart sapma
= 6.65) olarak bulundu. İşlem başarı oranı ise 86.3%’di. Hastane içi mortalite
görülmedi. Sonuç: Çok yaşlı
hastalarda terapötik endoskopik retrograd kolanjiopankreatografi pankreatobiliyer
hastalıklar için güvenilir ve etkili bir tedavi yöntemidir. Doksan yaş üzerinde
olup, Charlson Komorbidite İndeksi ≥ 2 kriterleri başarılı endoskopik retrograd
kolanjiopankreatografi işlemlerinde dahi bağımsız birer morbidite artışı
göstergeleridir. Endoskopik retrograd kolanjiopankreatografi çok yaşlı
hastalarda tercih edilen tedavi seçeneği olmalıdır.

Anahtar Kelimeler

Endoskopik retrograd kolanjiopankreatografi, çok yaşlı hastalar, güvenilirlik, yan etkiler, sonuçlar

Endoscopic retrograde cholangiopancreatography in super-elderly patients: Is it safe?

Öz

Background and Aims:
There is no consensus, nor is there sufficient data, on the safety of
endoscopic retrograde cholangiopancreatography in super-elderly patients. The
demand for endoscopic retrograde cholangiopancreatography is increasing
concurrently with the increasing human life expectancy. The aim of this study
is, therefore, to assess the outcomes and safety of endoscopic retrograde
cholangiopancreatography in super-elderly patients. Materials and Methods: The study sample consisted of 51 patients over
90 years of age who underwent endoscopic retrograde cholangiopancreatography between
January 2014 and December 2018. Patients’ demographic characteristics, indications,
procedure-, and anesthesia- related adverse events, American Society of
Anesthesiologists classification, the presence of comorbidities, and outcomes
were analyzed. The
Charlson Comorbidity Index was used to analyze comorbidity. A cutoff of Charlson
Comorbidity Index ≥2 was used to identify patients on the basis of
comorbidities. Results: The mean age
of the 51 included participants was 91.86 (Standard Deviation = 2.42) years,
and 16 of them were male. Bile duct stones were the most frequent indication
(66.7%). Sphincterotomy was performed on 42 participants (82.4%). A stent was
used in 17 participants (33.3%). The rate of difficult cannulation was 23.5%. Nine (17.6%) and 12 (24%) participants had
minor procedure- and anesthesia-related adverse events, respectively. The mean
procedure time was 35.16 (Standard Deviation = 6.65) minutes. Overall success
was 86.3%. In-patient mortality was not seen. Conclusion:
Therapeutic endoscopic
retrograde cholangiopancreatography is a safe
and effective treatment for pancreatobiliary disorders in super-elderly patients. Age ≥90 and a
Charlson Comorbidity Index ≥2 are
independently associated with increased morbidity in patients undergoing endoscopic
retrograde cholangiopancreatography, which
is successful and well tolerated. Endoscopic retrograde
cholangiopancreatography should remain the treatment of choice for super-elderly
patients.

Anahtar Kelimeler

Endoscopic retrograde cholangiopancreatography, super-elderly patients, safety, adverse events, outcomes

Kaynakça

• 1. Han SJ, Lee TH, Park SH, et al. Efficacy of midazolam- versus propofol-based sedations by non-anesthesiologists during therapeutic endoscopic retrograde cholangiopancreatography in patients aged over 80 years. Dig Endosc 2017;29:369-76.
• 2. Day LW, Lin L, Somsouk M. Adverse events in older patients undergoing ERCP: a systematic review and meta-analysis. Endosc Int Open 2014; 2:28-36.
• 3. Vracko J, Markovic S, Wiechel KL. Conservative treatment versus endoscopic sphincterotomy in the initial management of acute cholecystitis in elderly patients at high surgical risk. Endoscopy 2006; 38:773-8.
• 4. Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010;71:446-54.
• 5. Yang JH, Li W, Si XK, Zhang JX, Cao YJ. Efficacy and safety of therapeutic ERCP in the elderly: A single center experience. Surg Laparosc Endosc Percutan Tech 2018;28:44-8.
• 6. Köklü S, Parlak E, Yüksel O, Sahin B. Endoscopic retrograde cholangiopancreatography in the elderly: a prospective and comparative study. Age Ageing 2005;34:572-7.
• 7. Han SJ, Lee TH, Kang BI, Choi HJ, Lee YN, Cha SW. Efficacy and safety of therapeutic endoscopic retrograde cholangiopancreatography in the elderly over 80 years. Dig Dis Sci. 2016;61:2094-2101.
• 8. Katsinelos P, Lazaraki G, Chatzimavroudis G, et al. Risk factors for therapeutic ERCP-related complications: an analysis of 2,715 cases performed by a single endoscopist. Ann Gastroenterol 2014;27:65-72.
• 9. Yun DY, Han J, Oh JS, et al. Is endoscopic retrograde cholangiopancreatography safe in patients 90 years of age and older? Gut Liver 2014;8:552-6.
• 10. Hui CK, Liu CL, Lai KC, et al. Outcome of emergency ERCP for acute cholangitis in patients 90 years of age and older. Aliment Pharmacol Ther 2004;19:1153-8.
• 11. Rustagi T, Jamidar PA. Endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events: post-ERCP pancreatitis. Gastrointest Endosc Clin N Am 2015;25:107-21.
• 12. El Nakeeb A, El Hanafy E, Salah T, et al. Post-endoscopic retrograde cholangiopancreatography pancreatitis: risk factors and predictors of severity. World J Gastrointest Endosc 2016;8:709-15.
• 13. Ukkonen M, Siiki A, Antila A, et al. Safety and efficacy of acute endoscopic retrograde cholangiopancreatography in the elderly. Dig Dis Sci 2016;61:3302-8.
• 14. Tyagi P, Sharma P, Sharma BC, Puri AS. Periampullary diverticula and technical success of endoscopic retrograde cholangiopancreatography. Surg Endosc 2009;23:1342-5.
• 15. Finkelmeier F, Tal A, Ajouaou M, et al. ERCP in elderly patients: increased risk of sedation adverse events but low frequency of post-ERCP pancreatitis. Gastrointest Endosc 2015;82:1051-9.
• 16. Harvey M, Sleigh J, Voss L, et al. Development of rapidly metabolized and ultrashort acting ketamine analogs. Anesth Analg. 2015;121:925-33
• 17. Tobias JD, Leder M. Procedural sedation: a review of sedative agents, monitoring and management of complications. Saudi J Anaest. 2011;5:395-410.
• 18. Tarıkçı Kılıç E, Kahraman Resul. Comparison of ketamine-propofol mixture (ketofol) and midazolam-meperidine in endoscopic retrograde cholangiopancretography (ERCP) for oldest old patients. Ther Clin Risk Manag 2019;15:755-63.
• 19. Hinkelbein J, Lamperti M, Akeson J, et al. European Society of Anesthesiology And European Board of Anaesthesiology guidelines for procedural sedation and analgesia adults. Eur J Anaesthesiol. 2018;35:6-24.